2017-04-27_REPORT - M1990134

• Permit No: M1990134
• IBM Index Class Name: REPORT
• Doc Date: 4/27/2017
• Doc Name: Annual Fee/Report/Map
• From: James H & Kathleen H Ross
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Bud Bower
Permittee Company: James H&Kathleen H Ross
Address: 595 Taylor
Craig, CO 81625
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Richard E.Bower
Company: Bower Brothers Construction
Address: 595 Taylor St
Craig, CO 81625
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Richard E.Bower
Company: James H&Kathleen H Ross
Address: 595 Taylor St
Craig, CO 81625
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in
accordance with the Division approved mining and reclamation plans.
a7
Signature 6f Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01